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Walsh M, Uretsky M, Tripodis Y, Nowinski CJ, Rasch A, Bruce H, Ryder M, Martin BM, Palmisano JN, Katz DI, Dwyer B, Daneshvar DH, Walley AY, Kim TW, Goldstein LE, Stern RA, Alvarez VE, Huber BR, McKee AC, Stein TD, Mez J, Alosco ML. Clinical and Neuropathological Correlates of Substance Use in American Football Players. J Alzheimers Dis 2024:JAD240300. [PMID: 39269838 DOI: 10.3233/jad-240300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Background Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy more frequently found in deceased former football players. CTE has heterogeneous clinical presentations with multifactorial causes. Previous literature has shown substance use (alcohol/drug) can contribute to Alzheimer's disease and related tauopathies pathologically and clinically. Objective To examine the association between substance use and clinical and neuropathological endpoints of CTE. Methods Our sample included 429 deceased male football players. CTE was neuropathologically diagnosed. Informant interviews assessed features of substance use and history of treatment for substance use to define indicators: history of substance use treatment (yes vs no, primary variable), alcohol severity, and drug severity. Outcomes included scales that were completed by informants to assess cognition (Cognitive Difficulties Scale, BRIEF-A Metacognition Index), mood (Geriatric Depression Scale-15), behavioral regulation (BRIEF-A Behavioral Regulation Index, Barratt Impulsiveness Scale-11), functional ability (Functional Activities Questionnaire), as well as CTE status and cumulative p-tau burden. Regression models tested associations between substance use indicators and outcomes. Results Of the 429 football players (mean age = 62.07), 313 (73%) had autopsy confirmed CTE and 100 (23%) had substance use treatment history. Substance use treatment and alcohol/drug severity were associated with measures of behavioral regulation (FDR-p-values<0.05, ΔR2 = 0.04-0.18) and depression (FDR-p-values<0.05, ΔR2 = 0.02-0.05). Substance use indicators had minimal associations with cognitive scales, whereas p-tau burden was associated with all cognitive scales (p-values <0.05). Substance use treatment had no associations with neuropathological endpoints (FDR-p-values>0.05). Conclusions Among deceased football players, substance use was common and associated with clinical symptoms.
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Affiliation(s)
- Michael Walsh
- Boston University Alzheimer's Disease Research Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Madeline Uretsky
- Boston University Alzheimer's Disease Research Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Research Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Christopher J Nowinski
- Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
| | - Abigail Rasch
- Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Hannah Bruce
- Boston University Alzheimer's Disease Research Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Megan Ryder
- Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Brett M Martin
- Boston University Alzheimer's Disease Research Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Joseph N Palmisano
- Boston University Alzheimer's Disease Research Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Douglas I Katz
- Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Brigid Dwyer
- Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Daniel H Daneshvar
- Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Theresa W Kim
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Lee E Goldstein
- Boston University Alzheimer's Disease Research Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Victor E Alvarez
- Boston University Alzheimer's Disease Research Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- National Center for PTSD, VA Boston Healthcare, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Bertrand Russell Huber
- Boston University Alzheimer's Disease Research Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- National Center for PTSD, VA Boston Healthcare, Jamaica Plain, MA, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- National Center for PTSD, VA Boston Healthcare, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Research Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Jamaica Plain, MA, USA
- National Center for PTSD, VA Boston Healthcare, Jamaica Plain, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Research Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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de Lima Filho NM, Fernandes SGG, Costa V, Araujo D, Godeiro Jr C, Guerra G, Guerra RO, Ribeiro KF. Levels of biomarkers associated with subconcussive head hits in mixed martial arts fighters. PeerJ 2024; 12:e17752. [PMID: 39221265 PMCID: PMC11365479 DOI: 10.7717/peerj.17752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/25/2024] [Indexed: 09/04/2024] Open
Abstract
Background Concussion and the damage resulting from this event related to brain function have been widely studied; however, little is known about subconcussive impacts, especially in Mixed Martial Arts (MMA) fighters, which is a combat and full contact sport in which most blows are aimed at the head. Objective This study aims to evaluate the biomarker levels associated with subconcussive hits to the head in MMA fighters. Methods This is an exploratory study in which 30 male subjects (10 MMA fighters, 10 healthy individuals who practice muscle training, and 10 healthy sedentary individuals) aged between 18 and 32 years (25.4 ± 3.8) were evaluated. These individuals underwent blood collection to assess their Ubiquitin C-terminal hydrolase (UCH-L1), Glial Fibrillary Acidic Protein (GFAP) and Brain Derived Neurotrophic Factor (BDNF) levels before, immediately after and 72 hours after the sparring session (for the fighters) and were compared between groups. Results Significant differences were found at baseline between active and healthy fighters in BDNF levels (p = 0.03). A significant reduction of BDNF levels were also observed between the post-immediate and 72h after the sparring session (p = 0.03). No differences were observed in the number or severity of symptoms reported by the fighters. Conclusion Despite the exploratory approach, the findings of this study may help to understand the influence of repeated subconcussive hits to the head in MMA fighters, as well as to propose preventive interventions which can minimize the effects of the impact of hits, preserving fighters' neuronal integrity and function.
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Affiliation(s)
| | | | - Valeria Costa
- Health Science Center, Postgraduate Program in Drug Development and Technological Innovation, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Daline Araujo
- Health Sciences College of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | - Clecio Godeiro Jr
- Department of Integrated Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Gerlane Guerra
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Brazil
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Broglio SP, Register-Mihalik JK, Guskiewicz KM, Leddy JJ, Merriman A, Valovich McLeod TC. National Athletic Trainers' Association Bridge Statement: Management of Sport-Related Concussion. J Athl Train 2024; 59:225-242. [PMID: 38530653 DOI: 10.4085/1062-6050-0046.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To provide athletic trainers and team physicians with updated recommendations to the 2014 National Athletic Trainers' Association (NATA) concussion position statement regarding concussion management, specifically in the areas of education, assessment, prognostic factors, mental health, return to academics, physical activity, rest, treatment, and return to sport. BACKGROUND Athletic trainers have benefited from the 2 previous NATA position statements on concussion management, and although the most recent NATA position statement is a decade old, knowledge gains in the medical literature warrant updating several (but not all) recommendations. Furthermore, in various areas of the body of literature, current evidence now exists to address items not adequately addressed in the 2014 statement, necessitating the new recommendations. This document therefore serves as a bridge from the 2014 position statement to the current state of concussion evidence, recommendations from other organizations, and discrepancies between policy and practice. RECOMMENDATIONS These recommendations are intended to update the state of the evidence concerning the management of patients with sport-related concussion, specifically in the areas of education; assessment advances; prognostic recovery indicators; mental health considerations; academic considerations; and exercise, activity, and rehabilitation management strategies.
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Affiliation(s)
| | - Johna K Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science and Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Kevin M Guskiewicz
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science and Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - John J Leddy
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY
| | | | - Tamara C Valovich McLeod
- Athletic Training Program, A.T. Still University, Mesa, AZ. Dr Guskiewicz is now at the Department of Kinesiology, Michigan State University, East Lansing
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Kercher KA, Steinfeldt JA, Rettke DJ, Zuidema TR, Walker MJ, Martinez Kercher VM, Silveyra P, Seo DC, Macy JT, Hulvershorn LA, Kawata K. Association Between Head Impact Exposure, Psychological Needs, and Indicators of Mental Health Among U.S. High School Tackle Football Players. J Adolesc Health 2023; 72:502-509. [PMID: 36610880 PMCID: PMC10033334 DOI: 10.1016/j.jadohealth.2022.11.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Age of first exposure to tackle football and head impact kinematics have been used to examine the effect of head impacts on mental health outcomes. These measures coupled with retrospective and cross-sectional designs have contributed to conflicting results. The purpose of this study was to identify the effect of one season of head impact exposure, age of first exposure to football, and psychological need satisfaction on acute mental health outcomes in adolescent football players. METHODS This prospective single-season cohort study used sensor-installed mouthguards to collect head impact exposure along with surveys to assess age of first exposure to football, psychological satisfaction, depressive symptoms, anxiety symptoms, and thriving from football players at four high schools (n = 91). Linear regression was used to test the association of head impact exposure, age of first exposure, and psychological satisfaction with acute mental health outcomes. RESULTS A total of 9,428 impacts were recorded with a mean of 102 ± 113 impacts/player. Cumulative head impact exposure and age of first exposure were not associated with acute mental health outcomes at postseason or change scores from preseason to postseason. Greater psychological satisfaction was associated with fewer depressive symptoms (β = -0.035, SE = 0.008, p = < .001), fewer anxiety symptoms (β = -0.021, SE = 0.008, p = .010), and greater thriving scores (β = 0.278, SE = 0.040, p = < .001) at postseason. DISCUSSION This study does not support the premise that greater single-season head impact exposure or earlier age of first exposure to tackle football is associated with worse acute mental health indicators over the course of a single season in adolescent football players.
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Affiliation(s)
- Kyle A Kercher
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Jesse A Steinfeldt
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, Indiana
| | - Devin J Rettke
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Taylor R Zuidema
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Miata J Walker
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, Indiana
| | - Vanessa M Martinez Kercher
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Patricia Silveyra
- Department of Environmental and Occupational Health, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Dong-Chul Seo
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Jonathan T Macy
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Leslie A Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana; Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, Indiana; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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Moley JP, Norman JL, Coccaro EF. Personality disorder and mild traumatic brain injury. Personal Ment Health 2022; 16:331-337. [PMID: 35598165 PMCID: PMC9675684 DOI: 10.1002/pmh.1550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 12/30/2022]
Abstract
Mild traumatic brain injury (mTBI) poses risk to the neurocognitive, emotional, and financial well-being of affected individuals. While aggression and impulsivity have been examined in relation to mTBI, little work has been done to evaluate the relationship between history of mTBI and personality disorder (PD). The authors examined the associations between history of mTBI and PD in a control group without history of mTBI (N = 1189) and individuals with history of mTBI (N = 267). Results demonstrated that any PD diagnosis is a significant risk factor for mTBI (p < 0.001). Cluster B diagnoses, particularly borderline and antisocial PD, were independently significant risk factors for mTBI. These data suggest a role for screening for a history of mTBI in patients with PDs and associated traits.
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Affiliation(s)
- James P Moley
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Joshua L Norman
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Emil F Coccaro
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH
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Montero A, Stevens D, Adams R, Drummond M. Sleep and Mental Health Issues in Current and Former Athletes: A Mini Review. Front Psychol 2022; 13:868614. [PMID: 35465516 PMCID: PMC9023010 DOI: 10.3389/fpsyg.2022.868614] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Sleep and mental health are important aspects of human health that work concurrently. However, sleep and mental health disorders are often overlooked and undiagnosed in sport due to the negative stigma associated with them. Evidence suggests that athletes are disproportionately affected by mental health issues and sleep problems. Internal and external pressures contribute to psychological distress. Variable competition times, travel and stress are detrimental to sleep quality. Retirement from sport can deteriorate sleep and psychological wellbeing, particularly for those who retired involuntarily and identify strongly with their athletic role. When untreated, these issues can manifest into a range of clinical disorders. This is concerning, not only for compromised athletic performance, but for general health and wellbeing beyond sport. Previous research has focussed on sleep and health independently among currently competing, or former, athletes. To date, no research has comprehensively assessed and compared sleep complaints and mental health issues between these two cohorts. Moreover, research has failed to obtain data across a variety of different competition levels, sports, and genders, leaving the current scope of the literature narrow. Comorbid conditions (e.g., concussion history, obesity), ex-college athletes, and mental health has been the focus of existing literature post-retirement. Future research would benefit from employing both quantitative and qualitative methodologies to comprehensively assess the prevalence and severity of sleep and mental health disorders across current and retired athletes. Research outcomes would inform education strategies, safeguarding athletes from these issues by reducing negative stigmas associated with help-seeking in sport and ultimately increase self-guided treatment.
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Affiliation(s)
- Ashley Montero
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia
- Sport, Health, Activity, Performance and Exercise (SHAPE) Research Centre, Flinders University, Bedford Park, SA, Australia
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - David Stevens
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Robert Adams
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Murray Drummond
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia
- Sport, Health, Activity, Performance and Exercise (SHAPE) Research Centre, Flinders University, Bedford Park, SA, Australia
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Brett BL, Kerr ZY, Walton SR, Chandran A, Defreese JD, Mannix R, Echemendia RJ, Meehan WP, Guskiewicz KM, McCrea M. Longitudinal trajectory of depression symptom severity and the influence of concussion history and physical function over a 19-year period among former National Football League (NFL) players: an NFL-LONG Study. J Neurol Neurosurg Psychiatry 2022; 93:272-279. [PMID: 34663623 PMCID: PMC8854336 DOI: 10.1136/jnnp-2021-326602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/03/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study investigated the longitudinal course of depressive symptom severity over 19 years in former American football players and the influence of concussion history, contact sport participation and physical function on observed trajectories. METHODS Former American football players completed a general health questionnaire involving demographic information, medical/psychiatric history, concussion/football history and validated measures of depression and physical function at three time points (2001, 2010 and 2019). Parallel process latent growth curve modelling tested associations between concussion history, years of football participation, and overall and change in physical function on the overall level and trajectory of depressive symptoms. RESULTS Among the 333 participants (mean(SD) age, 48.95 (9.37) at enrolment), there was a statistically significant, but small increase in depressive symptom severity from 2001 (48.34 (7.75)) to 2019 (49.77 (9.52)), slope=0.079 (SE=0.11), p=0.007. Those with greater concussion history endorsed greater overall depressive symptom severity, B=1.38 (SE=0.33), p<0.001. Concussion history, B<0.001 (SE=0.02), p=0.997 and years of participation, B<0.001 (SE=0.01), p=0.980, were not associated with rate of change (slope factor) over 19 years. Greater decline in physical function, B=-0.71 (SE=0.16), p<0.001, was predictive of a faster growth rate (ie, steeper increase) of depression symptom endorsement over time. CONCLUSIONS Concussion history, not years of participation, was associated with greater depressive symptom severity. Neither factor was predictive of changes over a 19-year period. Decline in physical function was a significant predictor of a steeper trajectory of increased depressive symptoms, independent of concussion effects. This represents one viable target for preventative intervention to mitigate long-term neuropsychiatric difficulties associated with concussion across subsequent decades of life.
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Affiliation(s)
- Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
- Department of Neurology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Samuel R Walton
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, indianapolis, IN, USA
| | - J D Defreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Ruben J Echemendia
- Psychological and Neurobehavioral Associates, Inc, State College, Pennsylvania, USA
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - William P Meehan
- Sports Medicine Division, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA, USA
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
- Department of Neurology, Medical College of Wisconsin, Wauwatosa, WI, USA
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Colagrai AC, Barreira J, Nascimento FT, Fernandes PT. The paradox of mental health versus mental disease in elite athletes: a scoping review. MOTRIZ: REVISTA DE EDUCACAO FISICA 2022. [DOI: 10.1590/s1980-6574202200001722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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9
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Jónsdóttir MK, Kristófersdóttir KH, Runólfsdóttir S, Kristensen ISU, Sigurjónsdóttir HÁ, Eggertsdóttir Claessen LÓ, Kristjánsdóttir H. Concussion among female athletes in Iceland: Stress, depression, anxiety, and quality of life. NORDIC PSYCHOLOGY 2021. [DOI: 10.1080/19012276.2021.2004916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- María K. Jónsdóttir
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavík, Iceland
- Landspitali-The National University Hospital of Iceland, Reykjavík, Iceland
| | | | - Silja Runólfsdóttir
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavík, Iceland
| | - Ingunn S. U. Kristensen
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavík, Iceland
| | - Helga Á. Sigurjónsdóttir
- Landspitali-The National University Hospital of Iceland, Reykjavík, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Lára Ósk Eggertsdóttir Claessen
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
- Hamraborg Primary Health Care Center, Kópavogur, Iceland
| | - Hafrún Kristjánsdóttir
- Physical Activity, Physical Education, Sport and Health (PAPESH) Research Centre, Sports Science Department, School of Social Sciences, Reykjavik University, Reykjavík, Iceland
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Fossati C, Torre G, Vasta S, Giombini A, Quaranta F, Papalia R, Pigozzi F. Physical Exercise and Mental Health: The Routes of a Reciprocal Relation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312364. [PMID: 34886090 PMCID: PMC8656946 DOI: 10.3390/ijerph182312364] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 01/18/2023]
Abstract
Sport participation and exercise practice are considered to be beneficial for mental status, yielding an improved mood and better quality of life. On the other hand, good mental fitness is thought to lead to better physical status and sport performance. The key aim of this narrative review is to provide an unstructured overview on the topic with special considerations on the role of mental and physical health to summarize the evidence on their reciprocal influence. While very few papers describe the role of mental health measures in affecting physical performance, more evidence is available concerning the effect of exercise and sport in improving mental health outcomes. Furthermore, there is a consistent role of depressive and anxiety symptoms in influencing the risk of sport injury in either recreational or elite athletes. Moreover, the importance of investigating mental health issues in elite and retired athletes is highlighted. On the basis of the available literature, several biases were found to affect the provided evidence mainly because of the complexity of a proper study design in this field.
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Affiliation(s)
- Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (C.F.); (A.G.); (F.Q.); (F.P.)
| | - Guglielmo Torre
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (S.V.); (R.P.)
- Correspondence:
| | - Sebastiano Vasta
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (S.V.); (R.P.)
| | - Arrigo Giombini
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (C.F.); (A.G.); (F.Q.); (F.P.)
| | - Federico Quaranta
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (C.F.); (A.G.); (F.Q.); (F.P.)
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (S.V.); (R.P.)
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (C.F.); (A.G.); (F.Q.); (F.P.)
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11
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Howell DR, Kirkwood MW, Laker S, Wilson JC. Collision and Contact Sport Participation and Quality of Life Among Adolescent Athletes. J Athl Train 2021; 55:1174-1180. [PMID: 33112960 DOI: 10.4085/1062-6050-0536.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Researchers investigating collision and contact sport participation during high school have found mixed results. Understanding the association between current contact and collision sport participation and quality-of-life outcomes can enhance our knowledge about the risks and benefits of sport participation. OBJECTIVE To examine quality-of-life outcomes among high school athletes who reported participation in collision and contact sports in the year preceding assessment compared with no- or limited-contact sport athletes. DESIGN Cross-sectional study. SETTING Preparticipation physical examination. PATIENTS OR OTHER PARTICIPANTS High school athletes 13 to 18 years of age. MAIN OUTCOME MEASURE(S) We obtained sport participation and Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric-25 outcomes, which assess self-reported, quality-of-life domains in the preceding 7 days (ie, state assessment). Our grouping variable was collision and contact versus no- or limited-contact sport participation during the year preceding assessment. We used multivariable linear regression models to identify the associations between PROMIS scores and collision and contact sport participation and adjusted for sex; age; history of bone, muscle, ligament, or tendon injury; history of acute fracture or dislocation; and history of concussion. RESULTS A total of 143 (51%) athletes reported collision and contact sport participation (24% female, mean age = 15.1 ± 1.7 years) and 138 (49%) reported no- or limited-contact sport participation (66% female, mean age = 15.4 ± 1.2 years). A higher proportion of collision and contact sport athletes reported a history of time loss for bone, muscle, ligament, and tendon injuries (51% versus 29%, P < .001) and for acute fracture or dislocation (46% versus 26%, P < .001) than did no- or limited-contact athletes. After adjusting for covariates, we found that collision and contact sport participation was significantly associated with lower state anxiety (β = -1.072, 95% confidence interval = -1.834, -0.310, P = .006) and depressive (β = -0.807, 95% confidence interval = -1.484, -0.130, P = .020) symptom scores. CONCLUSIONS Collision and contact sport athletes reported fewer anxiety and depressive symptoms in the week preceding evaluation than did no- or limited-contact sport athletes, but they had more extensive orthopaedic injury histories. Potential benefits and risks are associated with collision and contact sport participation. These data reinforce the need to examine the assumption that youth collision and contact sports are associated with negative quality of life.
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Affiliation(s)
- David R Howell
- Departments of Orthopedics, Sports Medicine Center, and Rehabilitation Medicine, Children's Hospital Colorado, Aurora.,Department of Orthopaedics, University of Colorado School of Medicine, Aurora
| | - Michael W Kirkwood
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora
| | - Scott Laker
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora
| | - Julie C Wilson
- Departments of Orthopedics, Sports Medicine Center, and Rehabilitation Medicine, Children's Hospital Colorado, Aurora.,Department of Orthopaedics, University of Colorado School of Medicine, Aurora.,Pediatrics, University of Colorado School of Medicine, Aurora
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12
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Kercher K, Steinfeldt JA, Macy JT, Ejima K, Kawata K. Subconcussive head impact exposure between drill intensities in U.S. high school football. PLoS One 2020; 15:e0237800. [PMID: 32797073 PMCID: PMC7428124 DOI: 10.1371/journal.pone.0237800] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/31/2020] [Indexed: 12/14/2022] Open
Abstract
USA Football established five levels-of-contact to guide the intensity of high school football practices. The objective of this study was to examine head impact frequency and magnitude by levels-of-contact to determine which drills had the greatest head impact exposure. Our primary hypothesis was that there would be an incremental increase in season-long head impact exposure between levels-of-contact: air<bags<control<thud<live. This observational study included 24 high-school football players during all 46 practices, 1 scrimmage, 9 junior varsity and 10 varsity games in the 2019 season. Players wore a sensor-installed mouthguard that monitored head impact frequency, peak linear acceleration (PLA), and rotational acceleration (PRA). Practice/game drills were filmed and categorized into five levels-of-contact (air, bags, control, thud, live), and head impact data were assigned into one of five levels-of-contact. Player position was categorized into lineman, hybrid, and skill. A total of 6016 head impacts were recorded during 5 levels-of-contact throughout the season. In the overall sample, total number of impacts, sum of PLA, and PRA per player increased in a near incremental manner (air<bags<control = thud<live), where live drills had significantly higher cumulative frequency (113.7±17.8 hits/player) and magnitude [2,657.6±432.0 g (PLA), and 233.9 ± 40.1 krad/s2 (PRA)] than any other levels-of-contact, whereas air drills showed the lowest cumulative frequency (7.7±1.9 hits/player) and magnitude [176.9±42.5 g (PLA), PRA 16.7±4.2 krad/s2 (PRA)]. There was no significant position group difference in cumulative head impact frequency and magnitude in a season. Although there was no difference in average head impact magnitude across five levels-of-contact and by position group PLA (18.2–23.2g) and PRA (1.6–2.3krad/s2) per impact], high magnitude (60-100g and >100g) head impacts were more frequently observed during live and thud drills. Level-of-contact influences cumulative head impact frequency and magnitude in high-school football, with players incurring frequent, high magnitude head impacts during live, thud, and control. It is important to consider level-of-contact to refine clinical exposure guidelines to minimize head impact burden in high-school football.
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Affiliation(s)
- Kyle Kercher
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana, United States of America
| | - Jesse A. Steinfeldt
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, Indiana, United States of America
| | - Jonathan T. Macy
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana, United States of America
| | - Keisuke Ejima
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana, United States of America
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana, United States of America
- Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, Indiana, United States of America
- * E-mail:
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13
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Lefebvre G, Guay S, Chamard E, Theaud G, de Guise E, Bacon BA, Descoteaux M, De Beaumont L, Théoret H. Diffusion Tensor Imaging in Contact and Non-Contact University-Level Sport Athletes. J Neurotrauma 2020; 38:529-537. [PMID: 32640880 DOI: 10.1089/neu.2020.7170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Subconcussive hits to the head and physical fitness both have been associated with alterations in white matter (WM) microstructure in partly overlapping areas of the brain. The aim of the present study was to determine whether WM damage associated with repeated exposure to subconcussive hits to the head in university level contact sports athletes is modulated by high levels of fitness. To this end, 72 students were recruited: 24 athletes practicing a varsity contact sport (A-CS), 24 athletes practicing a varsity non-contact sport (A-NCS), and 24 healthy non-athletes (NA). Participants underwent a magnetic resonance imaging session that included diffusion-weighted imaging. Between-groups, statistical analyses were performed with diffusion tensor imaging measures extracted by tractometry of sections of the corpus callosum and the corticospinal tract. Most significant effects were found in A-NCS who exhibited higher fractional anisotropy (FA) values than A-CS in almost all segments of the corpus callosum and in the corticospinal tract. The A-NCS also showed higher FA compared with NA in the anterior regions of the corpus callosum and the corticospinal tracts. No group difference was found between the A-CS and the NA groups. These data suggest that repeated subconcussive hits to the head lead to anisotropic changes in the WM that may counteract the beneficial effects associated with high levels of fitness.
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Affiliation(s)
- Geneviève Lefebvre
- Department of Psychology and Université de Montréal, Montréal, Québec, Canada
| | - Samuel Guay
- Department of Psychology and Université de Montréal, Montréal, Québec, Canada
| | - Emilie Chamard
- Department of Psychology and Université de Montréal, Montréal, Québec, Canada
| | - Guillaume Theaud
- Sherbrooke Connectivity Imaging Laboratory (SCIL), Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Elaine de Guise
- Department of Psychology and Université de Montréal, Montréal, Québec, Canada
| | | | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Laboratory (SCIL), Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Louis De Beaumont
- Department of Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Hugo Théoret
- Department of Psychology and Université de Montréal, Montréal, Québec, Canada.,Research Center, CHU Sainte-Justine, Montréal, Québec, Canada
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14
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Hunt C, Zahid S, Ennis N, Michalak A, Masanic C, Vaidyanath C, Bhalerao S, Cusimano MD, Baker A. Quality of life measures in older adults after traumatic brain injury: a systematic review. Qual Life Res 2019; 28:3137-3151. [PMID: 31522371 PMCID: PMC6864113 DOI: 10.1007/s11136-019-02297-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND On average older adults experiencing TBI are hospitalized four times as often, have longer hospital stays, and experience slower recovery trajectories and worse functional outcomes compared to younger populations with the same injury severity. A standard measure of Qol for older adults with TBI would facilitate accurate and reliable data across the individual patient care continuum and across clinical care settings, as well as support more rigorous research studies of metadata. PURPOSE The aim of this systematic review was to investigate patient reported Qol measures in studies with older adults post TBI. METHOD A systematic review was carried out focusing on the various tools to measure Qol in older adults, ≥ 65 years of age with a diagnosis of TBI. Data bases searched included Medline, Embase, PubMed, CINAHL, and PsychInfo from date of inception to September 25, 2017. RESULTS A total of 20 articles met the inclusion criteria. Nine different tools were identified. CONCLUSIONS Findings based on the comparison of reliability and construct validity of the Qol measures reported in this review suggest that no single instrument is superior to all others for our study population. Future research in this field should include the enrollment of larger study samples of older adults. Without these future efforts, the ability to detect an optimal Qol measure will be hindered.
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Affiliation(s)
- Cindy Hunt
- Head Injury Clinic, Trauma and Neurosurgery Program, St. Michael’s Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | | | - Naomi Ennis
- Department of Psychology, Ryerson University, Toronto, ON Canada
| | - Alicja Michalak
- Head Injury Clinic, Trauma and Neurosurgery Program, St. Michael’s Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Cheryl Masanic
- St. Michael’s Head Injury Clinic and UHN Toronto Rehabilitation Clinic Toronto, Toronto, ON Canada
| | - Chantal Vaidyanath
- St. Michael’s Head Injury Clinic and UHN Toronto Rehabilitation Clinic Toronto, Toronto, ON Canada
| | | | - Michael D. Cusimano
- Department of Surgery, Division of Neurosurgery, Injury Prevention Research Office, Keenan Research Centre, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Andrew Baker
- Departments of Anesthesia and Critical Care, Keenan Research Centre for Biomedical Science, St. Michael’s Hospital Toronto, University of Toronto, Toronto, ON Canada
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15
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Newman SD, Grantz JG, Brooks K, Gutierrez A, Kawata K. Association between History of Concussion and Substance Use Is Mediated by Mood Disorders. J Neurotrauma 2019; 37:146-151. [PMID: 31359826 DOI: 10.1089/neu.2019.6550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Understanding the impact of concussion history on mental health-mood disorders and substance use-is an essential step in characterizing the psychological and behavioral consequences of concussion and in developing effective treatments. The objective of this study was to examine the association between the history of concussion and substance abuse by investigating both its direct and indirect association via mood disorder. A secondary objective was to determine whether gender moderates the association. A comprehensive survey was administered to 4849 college-age adults that assessed history of concussion; depression, anxiety, and panic disorders using the Patient Health Questionnaire (PHQ); and substance use using the Alcohol Use Disorders Identification Test (AUDIT) (alcohol) and Cannabis Use Disorders Identification Test-Revised (CUDIT) (cannabis). Regression models were used to examine the association between concussion history and substance use. Mood disorders were entered into the model as mediators and gender as a moderator variable. Those with a history of concussion had higher panic, AUDIT, and CUDIT scores than those with no history of concussion, and AUDIT and CUDIT scores showed an interaction between concussion history and gender. The regression models revealed significant direct and indirect (via depression and panic disorder) effects of concussion history on alcohol and cannabis use, which was moderated by gender. Concussion can have long-term psychological consequences and appears to affect both mood and substance use. The results presented demonstrate that the relationship between concussion and substance use is complex with mood disorder mediating the effect.
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Affiliation(s)
- Sharlene D Newman
- Department of Psychological and Brain Sciences, School of Public Health, Indiana University, Bloomington, Indiana.,Program in Neuroscience, College of Arts and Sciences, School of Public Health, Indiana University, Bloomington, Indiana
| | - Jesse G Grantz
- Department of Psychological and Brain Sciences, School of Public Health, Indiana University, Bloomington, Indiana
| | - Kelsie Brooks
- Department of Psychological and Brain Sciences, School of Public Health, Indiana University, Bloomington, Indiana
| | - Arianna Gutierrez
- Department of Psychological and Brain Sciences, School of Public Health, Indiana University, Bloomington, Indiana
| | - Keisuke Kawata
- Program in Neuroscience, College of Arts and Sciences, School of Public Health, Indiana University, Bloomington, Indiana.,Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
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